LeadingAge Nursing Home Advisory Group - March 2021

Regulation | March 31, 2021 | by Jodi Eyigor

Dr. Kara Jacobs Slifka of CDC’s Division of Healthcare Quality Promotion joined the Nursing Home Advisory Group call on March 30, 2021.

Dr. Kara Jacobs Slifka of The Center for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion joined the Nursing Home Advisory Group call on March 30, 2021 to discuss the latest updates to CDC guidance and answer questions from LeadingAge nursing home members. Her review of 2 updated pieces of long-term care guidance was then followed by policy updates from LeadingAge staff and a short, facilitated discussion with group participants on vaccination access plans.

News from CDC

Dr. Jacobs Slifka reviewed 2 key pieces of CDC guidance, recently updated. The Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination were most recently updated on March 10 and outline recommendations for fully vaccinated healthcare personnel while at work and residents while living in long-term care settings. Topics addressed include visitation in the long-term care setting; work restriction for asymptomatic healthcare personnel and quarantine for asymptomatic patients and residents; SARS-CoV-2 testing; and use of personal protective equipment.

Visitation recommendations align with CMS guidelines, also updated March 10. CDC guidance continues to recommend quarantine for all residents or patients with prolonged exposure to COVID-19, regardless of vaccination status, but no longer recommends quarantine upon admission/readmission for fully-vaccinated residents or patients. Fully vaccinated healthcare personnel are also no longer recommended for work restriction following high-risk exposure in the healthcare setting. We note, however, that healthcare personnel must continue to follow any public health recommendations or state requirements for quarantine, which may result in work restriction. For example, healthcare personnel who travel out of state would be restricted from work, regardless of vaccination status, if the state requires quarantine following travel.

Dr. Jacobs Slifka also reviewed Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes. This guidance merges 2 prior documents, Responding to COVID-19 in Nursing Homes and Performing Facility-Wide SARS-CoV-2 Testing in Nursing Homes, and was released on March 29. Sections of this guidance include Infection Prevention and Control Program; Vaccinations; Source Control and Distancing Measures; Visitation; Personal Protective Equipment; Testing; Evaluating and Managing Personnel and Residents; Managing Residents with Close Contact; New Admissions and Residents Who Leave the Facility; and New Infection in Healthcare Personnel or Resident. Recommendations remains largely unchanged; however, this new guidance provides greater detail and clarification on several aspects of care. We note the section on Residents Who Leave the Facility will help nursing home providers in creating plans to safely allow residents to leave for social excursions, including considerations for when to require quarantine or additional mitigation measures upon return.

Policy Updates and Resources

Senate Hearings. Senate committees held 2 recent hearings spotlighting nursing homes this month. The Senate Finance Committee held a hearing on March 17 entitled A National Tragedy: COVID-19 in the Nation’s Nursing Homes. LeadingAge submitted written testimony for the hearing, which can be found here. The Senate Aging Committee held a hearing on March 18 entitled COVID-19 One Year Later: Addressing Healthcare Needs for At-Risk Americans. Themes that emerged during both hearings included a need to strengthen the long-term care workforce and increased transparency, including fiscal transparency and transparency around COVID-19 reporting. Private equity ownership in nursing homes appeared to be a sticking point and we expect to hear more on this issue in the future. We also note that John Dicken, director of the healthcare team in the Government Accountability Office noted that despite release of recommendations in September 2020 from the Commission for Safety and Quality in Nursing Homes, the Centers for Medicare and Medicaid Services (CMS) has yet to take action. We’ll be keeping an eye out for any response from CMS.

Drive for 75. To assist members in reaching a goal of fully vaccinating 75% of the aging services workforce by June 30, 2021, LeadingAge is featuring a “Drive for 75” segment on our national member calls. These calls take place every Monday, Wednesday, and Thursday and the Drive for 75 segment shares information, research, and strategies that members can employ now to impact vaccine acceptance. A weekly review of these segments is available here and is also included in our Nursing Home Weekly Recap available here.

Upcoming Life Safety Code / Emergency Preparedness webinar. Join experts Dave Hood and Colin McKay from RPA – a Jensen Hughes Company for Life Safety Code and Emergency Preparedness: Post-COVID Compliance on the LeadingAge Learning Hub April 8. This webinar will examine 1135 waivers, survey citations, and other hot issues as participants explore how to transition to post-COVID operations. Participants will also receive a template to help document their organizations’ responses to COVID-19 as an official emergency preparedness drill to satisfy federal requirements. Register for this webinar here.

Virtual Lobby Day. LeadingAge Lobby Day is April 21. Previously part of our annual Leadership Summit, this year’s Lobby Day will be 100% virtual, increasing access to advocacy for members across our continuum and throughout multiple levels of staff within membership organizations. There has never been a more important time to tell your story. LeadingAge will assist members in advocating to their members of Congress through virtual visits, as well as supporting members in preparation for these visits through a national call on April 14 and state-level calls scheduled for April 15-20. Learn more and register to take part in Lobby Day here.

Care for Our Seniors Act. LeadingAge has partnered with American Health Care Association (AHCA) on the Care for Our Seniors Act, a set of policy recommendations aimed at ensuring quality in nursing homes. The proposal identifies 4 key principles for reform: clinical, workforce, oversight, and structural. The proposal also suggests strategies for funding these reforms, drawing on resources at both the federal level and state level. More information on the proposal, including an overview, one-pager, and issue briefs for key components of the reform principles can be found here.

Pathway Health Toolkits. LeadingAge has been working with partners Pathway Health to bring COVID-19 toolkits to members. The most recently updated toolkit on nursing home visitation features general information on CMS visitation guidelines, an implementation checklist that tracks alongside CMS guidance and requirements, policy template, competency tools, training, and training post-tests. LeadingAge has also created a visitation checklist to help supplement members’ efforts to provide safe visitation in their communities. Additional resources from Pathway Health include toolkits for testing, vaccination, universal source control and physical distancing, activities reopening, access to adequate PPE, optimizing PPE, and local hospital capacity. All toolkits are available here and can be accessed with your LeadingAge login.

Member Feedback

To round out our call, we asked members about key concerns or experiences in efforts to facilitate access to vaccination for residents and staff beyond the Long-Term Care Pharmacy Partnership Program, wrapping up this month. CDC has strongly encouraged nursing home providers to work with long-term care pharmacies through the Retail Pharmacy Program in the next phase of vaccine allocation. Several members on the call responded that they have had success in working with their own long-term care pharmacies to create a plan for the future. LeadingAge continues to work with CDC to ensure that all aging services providers and the individuals they serve have access to COVID-19 vaccination.